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i' <br /> BIbSIALr-,OWNER/OPERATOR ID :FI 'J0 { 5 � 2 <br /> a �.t: <br /> --- <br /> BUSINESS MAAILIN AND- BILLMLJNJ FO MATION <br /> MAIL X41) ) L J Q�:, �.!':;CS"YSc:PCcS <br /> (If diffCt r m`St�'ddress11 <br /> NOTE: All time sensitive and Street No. Direction Street Name Street Type <br /> official correspondence will <br /> be sent to this address <br /> CF Y STATE ZIP <br /> BILLING ADDRESS(42) <br /> If different from above, F/6J <br /> include"Care of information <br /> ADDITIONAL BUSINESS INFORMATION <br /> TYPE OF Ingle Owner ❑Partnership UNSTAFFED SITE NETWORK(44) <br /> ORGANIZATION (43) ❑Corporation ❑Public Agency ❑YES �NO <br /> ASSESSOR PARCEL NO. (45) <br /> O/� DSD z Z <br /> PROPERTY OWNER (46) PHONE NO. (47) <br /> NAME <br /> (If different from Business Owner) <br /> PROPERTY OWNER (48) <br /> ADDRESS <br /> Street Address <br /> CITY STATE ZIP <br /> FIRE DISTRICT (49) f <br /> NEAREST CROSS (50) <br /> STREET <br /> FACILITY (51) IF YES, <br /> LOCK BOX ❑YES NO WHERE IS TT LOCATED?(52) <br /> NATURE OF BUSINESS (53) n <br /> WASTE GENERATOR (54) pii:o�d IF YES, <br /> WHAT IS YOUR EPA NO.?(55) <br /> TRAINING PROGRAM INFORMATION <br /> Does your business have an employee training program that includes initial training and annual refreshers? (56) ❑yES �NO <br /> Does your business maintain written training records that show the training subject,date(s)of training, (57) ❑yES O <br /> names and signatures of employees trained, and names of instructor(s)? <br /> SJC 12/97 <br />